热性惊厥持续状态复发的危险因素分析

Risk factor analysis of recurrence of febrile status epilepticus

目的探讨儿童热性惊厥持续状态(FSE)复发的危险因素。方法收集138例FSE患儿的临床资料,并于出院后进行2个月至8.3年的随访。根据随访结果,将患儿分为热性惊厥复发组、癫痫进展组及无惊厥复发组,分析FSE复发的相关因素。结果根据随访结果,热性惊厥复发30例(21.7%)(热性惊厥复发组),8例(5.8%)进展为癫痫(癫痫进展组),100例(72.5%)无复发(无惊厥复发组)。与无惊厥复发组比较,热性惊厥复发组低热时出现惊厥、既往有热性惊厥病史、阳性惊厥家族史及异常EEG的比率显著升高(P<0.05~0.01)。多因素Logistic回归分析显示,低热时出现惊厥、既往有热性惊厥病史及阳性惊厥家族史为FSE热性惊厥复发的独立危险因素(P<0.05~0.01)。FSE进展为癫痫的危险因素为低热时出现惊厥、既往有热性惊厥病史、异常EEG及异常头颅MRI(P<0.05~0.01)。结论低热时出现惊厥、既往有热性惊厥病史及阳性惊厥家族史为FSE热性惊厥复发的独立危险因素。低热时出现惊厥、既往有热性惊厥病史、异常EEG及异常头颅MRI为FSE进展为癫痫的危险因素。对于有危险因素的FSE患儿,应早期合理选择预防用药,改善预后。

Objective To investigate the risk factors of recurrence of febrile status epilepticus(FSE). Methods The clinical data of 138 children with FSE were collected, and patients were followed up for 2 months to 8.3 years. According to the follow-up results, the children were divided into febrile seizures recurrence group, progression to epilepsy group and no seizure recurrence group. The risk factors of recurrence were analyzed. Results During follow-up, 30 cases(21.7%) had febrile seizures recurrence(febrile seizures recurrence group), 8 cases(5.8%) had progressed to epilepsy(progression to epilepsy group), and 100 cases(72.5%) had no seizure recurrence(no seizure recurrence group). Compared with those in the no seizure recurrence group, the rates of convulsions at low fever, prior febrile seizures, positive family history of convulsion and abnormal EEG in the febrile seizures recurrence group were significantly higher(P<0.05-0.01). The multivariate Logistic regression analysis showed that convulsions at low fever, prior febrile seizures and positive family history of convulsion were independent risk factors of recurrence of FSE(P<0.05-0.01). The risk factors for progression to epilepsy were convulsions at low fever, prior febrile seizures, abnormal EEG and abnormal craniocerebral MRI(P<0.05-0.01). Conclusions Convulsions at low fever, prior febrile seizures and positive family history of convulsion are independent risk factors of recurrence of FSE, and convulsions at low fever, prior febrile seizures, abnormal EEG and abnormal craniocerebral MRI are risk factors of FSE progression to epilepsy. For the FSE children with risk factors, appropriate prevention methods can reduce the recurrence of convulsion and improve the prognosis.